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Lisa Morgan 3/11/14 ENC 1102 Low-level laser therapy (LLLT) has become a recent technique in the physical therapy and medical discourse community. Laser therapy has become an important topic to study because it is new technology that can be more effective and a less of a cost for patients and doctors. This new technology could become a replacement for people who need to go through physical therapy muscles for injuries like tears. This is so they wont have to go through months or years of physical therapy and can just have the laser therapy procedure done. This topic has become recently studied within the last five to ten years because the technology is just becoming available and becoming more advanced and safe for people to study and to be experimented on. The academic articles that I annotated focus on low level laser therapy for muscles in the body. The studies are not just done on humans, but many were done with rats. This is because it is still a new source of therapy. All of the documents came from academic journals. This is because academic journals are where researchers can write about their research, introduce their research to their field or talk about other existing research going on. These articles are directed towards doctors and physical therapist because it is new technology that is still being studied today and will still need more research in the future. These articles are credible because they are written by professors who teach within the medical departments at many different universities. Many of these professors have either have a degree in Physical Therapy (PT) or have a PhD. All of the articles mention that there will still need to be more studies done whether or not the results they got from their study were positive.

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Basford J, Sheffield C, Cieslak K. Laser therapy: A randomized, controlled trial of the effects of low intensity Nd: YAG laser irradiation on lateral epicondylitis. Archives of Physical Medicine and Rehabilitation [serial online]. n.d.; 81(11):1504-1510. Available from: Science Citation Index, Ipswich, MA. Accessed February 27, 2014. Jeffery Basford, who has a Doctor of Medicine and a PhD, Charles Sheffield and Kathryn Cieslak, who are both Physical Therapist, conducted a study on lateral epicondylitis or more popularly known as tennis elbow and low-level laser therapy. Lateral epicondylitis is inflammation of the tendons in the elbow. The study was used to find if the pain and the tenderness of the tendon decrease. Fifty-two men and women with lateral epicondylitis who endured pain for more than thirty days. They were randomly selected and put into two different groups. One group was treated while the other was the control. They participated in sixty seconds of radiation at seven different points along the forearm. They did this process three times a week for four weeks. It was a double blind test so the subjects and therapists were concealed from knowing who was in the control group and who was not. The treated and untreated groups were equally matched demographically. There was no compelling differences between the two groups and no significant side effects were discovered. The study was found safe but an inefficient treatment for lateral epicondylitis. This is relevant to the audience because the findings could turn off interest doctors wanting to study or practice laser therapy. Brunelli R, Rodrigues N, Abreu D, et al. The effects of 780-nm low-level laser therapy on muscle healing process after cryolesion. Lasers in Medical Science [serial online]. January 2014; 29(1):91-96. Available from: Academic Search Premier, Ipswich, MA. Accessed March 1, 2014.

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The ten authors of this academic journal, either from The State University of Campinas, Federal University of So Carlos, or Federal University of So Paulo, set out to test muscle healing after cryolesion (the processes of freezing in order to injure) in rats. Fiftyfour male rats were divided into three groups. The first was the control group and the second and third groups were both test groups but with different levels of lasers (10j/cm and 50j/cm). The three groups were then divided into three subgroups to test different periods (seven, fourteen and twenty-one days). The procedure duplicated twice within a time interval of thirty seconds. After seven days the two tested groups showed a decreased amount inflammation and a greater organization of muscle tissue. After twenty-one days full muscle tissue repair was noticed in both groups. The results show that no matter the dosage applied there was a positive effect on the muscles of the rats. This journal fits into the discourse community because the positive results can help lead to more studies of muscle tissue repair and maybe even tested on humans. De Almeida P, Lopes-Martins R, Leal Junior E, et al. Low-level laser therapy improves skeletal muscle performance, decreases skeletal muscle damage and modulates mRNA expression of COX-1 and COX-2 in a dose-dependent manner. Photochemistry And Photobiology [serial online]. September 2011; 87(5):1159-1163. Available from: MEDLINE, Ipswich, MA. Accessed March 6, 2014 Of the seven authors, six work at the University of So Paulo in Brazil while the seventh works at Bergen University College in Norway. They wanted to test muscular performance, Creatine Kinases (CK), which is the amount of ATP, change after six contractions, and if certain enzymes (COX-1 and COX-2) can be related to effects of laser therapy in skeletal muscles. They used thirty-five male rats weighing about 150 to

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200 grams. They were put into five groups. First is the control group, second group received low level laser therapy (LLLT) at 0.1 joules (j), third group received LLLT at 0.3j, fourth group was administered the LLLT at 1.0j, and the last group received the LLLT at 3.0j. The nerve and tendons in the tibial (concerned with movements of the foot) were cut and fixed immediately. The LLLT dosage were based on previous studies. The 1.0j and 3.0j group both were found to have an increase in total work compared to the other groups. There was a decrease in CK activity in all laser groups except the 3.0j group. 1.0j group had increased COX-1 and a decrease in COX-2 compared with the control and other tested groups. The conclusion from this study is that LLLT can enhance the muscle performance and protects skeletal muscles against damage and inflammation. This is important to the discourse community because these findings will give a better understanding about low level laser therapy and help for further studies in the future. Eslamian F, Shakouri S, Ghojazadeh M, Nobari O, Eftekharsadat B. Effects of low-level laser therapy in combination with physiotherapy in the management of rotator cuff tendinitis. Lasers In Medical Science [serial online]. September 2012; 27(5):951-958. Available from: MEDLINE, Ipswich, MA. Accessed March 6, 2014. The five authors of the academic journal, Fariba Eslamian, Seyyed Shakouri, Morteza Ghojazadeh, Ozra Nobari, and Bina Eftekharsadat, all work at Tabriz University of Medical Sciences in Iran. The study focused on rotator cuff tendinitis, which is when the tendons and muscles around the shoulder are inflamed. They wanted to see if low-level laser therapy with conventional physical therapy would help patients with rotator cuff tendinitis. There was a total of fifty patients. They were spilt into two groups, the control group who only had physical therapy and the experimental group that had physical

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therapy and low level laser therapy. This was a double-blind test. To find the baseline they tested pain severity and rotation range of motion. The laser was applied to ten points on the shoulder for about five minutes. For the control group the laser was not turned on. The results found that low laser therapy paired with regular physical therapy was found to be more effective in decreasing pain and improving the patients function. There was no advantages in decreasing the range of motion in the shoulder. This is important to the conversation of the discourse community because low level laser therapy could become a more effective way to help with rotator cuff tendinitis. Ferraresi C, de Brito Oliveira T, Parizotto N, et al. Effects of low level laser therapy (808 nm) on physical strength training in humans. Lasers In Medical Science [serial online]. May 2011; 26(3):349-358. Available from: MEDLINE, Ipswich, MA. Accessed March 5, 2014. Out of the eight authors/researchers of this academic journal, seven work at the Federal University of So Carlos, while the eighth one works at the University of So Paulo. They are experts in different fields like biotechnology, physical therapy, and the physiology of exercise. They set out to find the effects of low-level laser therapy (LLLT) with physical strength training compared to strength training alone. The final sample amount of people that participated in the study was thirty. They were all males with a mean age of nineteen. The men were separated into three groups, TLG (training with LLLT), TG (training only), and CG (control group). The LLLT was applied to the quadriceps in both legs of the patients after each training session. The training consisted of leg presses. The TLG participants showed a fifty-five percent increase in the leg press test. TLG was the only group to show an increase in muscle performance compared to the

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baseline. There was no significant difference in the thigh perimeter between the TLG and TG. The combination of low level laser therapy and strength training was found remarkably better than just strength training only. This is important to the discourse community because it is positive data that can be useful for other doctors and patients. Higashi R, Toma R, Renno A, et al. Effects of Low-Level Laser Therapy on Biceps Braquialis Muscle Fatigue in Young Women. Photomedicine & Laser Surgery [serial online]. December 2013; 31(12):586-594. Available from: Academic Search Premier, Ipswich, MA. Accessed March 12, 2014. There are ten authors of this academic journal. They are from three different universities. The universities are Federal University of So Paulo, Federal University of So Carlos, and University Paulista Julio de Mesquita Filho. This study was done to test if muscular fatigue in the biceps could be delayed. Muscular fatigue is the decline in the ability of a muscle to generate force. It may cause muscle pain and or deterioration in motor skills. Twenty women between the ages of eighteen and twenty-five were the subjects of the study. They participants were randomly put into two groups and the treatment was split into two sessions. Group A received the laser treatment in the first session and the placebo the second session. Group B received the placebo in the first session and the laser treatment in the second session. They tested the laser therapy effectiveness through elbow flexion repetitions, electromyography (EMG) which measure muscle response, and measure the blood lactate, which is when lactic acid is released in the blood stream when there is insufficient oxygen in the muscle. There was no difference found for EMG fatigue and blood lactate between the two groups. Low level laser therapy had very limited effects on delaying muscle fatigue. Even those these findings may not be what the

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researchers were hoping to find but could lead to more studies practices with the muscle fatigue. Kulekcioglu S, Sivrioglu K, Ozcan O, Parlak M. Effectiveness of low-level laser therapy in temporomandibular disorder. Scandinavain Journal Of Rheumatology [serial online]. March 2003; 32(2): 114. Available from: Academic Search Premier, Ipswitch, MA. Accessed March 12, 2014 The four authors of this academic journal, all from Uludag University School of Medicine in Turkey, set out to study the effect of low-level laser therapy on temporomandibular disorder (TMD), characterized by symptoms involving muscles and the joints of the jaw, and to compare the effectiveness of the treatment to arthrogenic patients (peoples whose pain started at the jaw) and myogenic patients (peoples whose pain started in the muscle). There was a total of thirty-five patients, twenty-eight of which were female and seven of which were male. They were checked into the outpatient clinic of Uludag University Medical Faculty Department with symptoms ranging from limited mouth opening to joint sounds and locking. All patients were evaluated before, after and a month later after the treatment. The patient participated in an MRI to find out if they were arthrogenic or myogenic then were randomly assigned to two groups (active group and placebo group). The active group had fifteen sessions of the low-level laser therapy while they didnt even turn the laser on for the placebo group, they also all took part in standard daily stretching exercises. Then they were evaluated by an investigators who was blind to the treatment groups. Through the results from this study the researchers found that even though there was no compelling difference between the myogenic and arthrogenic cases, the treated group did see an improvement in the movement of the jaw,

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and tender points. The only area they did not see significant improvement was in pain intensity and joint sounds. This relates to the conversation within the discourse community because it gives doctors and medical staff the knowledge to determine whether or not laser therapy treatment is a more effective option for their patients physical conditions. Leal J, Lopes-Martins R, Bjordal J, et al. Effect of 830 nm low-level laser therapy applied before high-intensity exercises on skeletal muscle recovery in athletes. Lasers in Medical Science [serial online]. November 2009; 24(6):857-863. Available from: Academic Search Premier, Ipswich, MA. Accessed March 14, 2014. There are thirteen authors and researchers of this article. They are either from University of Caxias do Sul (UCS) in Brazil or the University of Bergen in Norway. They set out to test the short term effects, like muscle fatigue of low-level laser therapy on people who take part in high intensity exercise. The volunteers were all male; nine volleyball players and eleven soccer players. The volleyball players were between the ages of eighteen and thirty-six, while the soccer players were between the ages of fifteen and eighteen. The athletes all performed the same exercise (cycling) but the volleyball players were evaluated by their creatine kinase levels (the amount of ATP) and the soccer players were evaluated by the levels of blood lactate (the amount of lactic acid in the blood stream). The exercises were implemented and the evaluated after two sessions, on day one and day eight. They made sure that this was performed on the same day both times and within the same period of time. At both sessions the participants were randomly either given the laser treatment or the placebo. The creatine kinase test after the exercises showed that there was lower change in muscle damage than in the placebo group. The blood lactate

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was found to increase compared to the baseline. These findings are important to the discourse community because they show that low level laser therapy can be an effective way to protect muscles in sports. Oliveira F, Pinfildi C, Ferreira L, et al. Effect of low level laser therapy (830 nm) with different therapy regimes on the process of tissue repair in partial lesion calcaneus tendon. Lasers in Surgery and Medicine [serial online]. April 2009; 41(4):271-276. Available from: MEDLINE, Ipswich, MA. Accessed March 12, 2014. The seven authors of this academic journal are from three different universities. The three universities are So Paulo Federal University, University Metodista of Piracicaba and Federal University of So Carlos, which are in Brazil. This study was conducted to test the repair on the calcaneus tendon. The calcaneus tendon is better known as the Achilles tendon which attaches the calf and the heel. It was a single blind test. Sixty male rats were randomly assigned to five different groups, each group containing twelve rats. Forty-two out of the sixty went through lesion caused by the dropping of a weight on the tendon. Group one was the control group. Group two suffered the lesion but did not get the laser treatment. Groups three, four, and five suffered the lesion and got the laser therapy on days three, five and seven. This was to analyze the collagen fibers. Collagen is a protein that helps with connective tissue. The total energy of the laser was 0.12 joules. After the eighth day the tendons were dissected and then studied. The study found that the groups that were treated with the laser had an improvement in terms of collagen fibers. So low level laser therapy is an effective way to improve the repair of the calcaneus tendon. This is important to the medical discourse community because it is an improvement in the use of lasers for repairing muscles.

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Patrocinio T, Sardim A, Assis L, Fernandes K, Rodrigues N, Renno A. Effect of Low-Level Laser Therapy (808 nm) in Skeletal Muscle After Resistance Exercise Training in Rats. Photomedicine & Laser Surgery [serial online]. October 2013; 31(10):492-498. Available from: Academic Search Premier, Ipswich, MA. Accessed March 14, 2014. Tatiane Patrocinio, Natalia Rodrigues and Ana Claudia Muniz Renno are in the Department of Physiotherapy at the Federal University of So Carlos. Andre Cabral Sardim, Livia Assis and Kelly Rossetti Fernandes are in the Department of Bioscience at the Federal University of So Paulo. This study was created to test the effects of lowlevel laser therapy after resistance training of the skeletal muscles in rats. They used thirty male rats at the age of week ages. Ten rats were randomly placed into three groups: control group (CG), trained group (TG), and trained and laser group (TLG). The laser was performed three times a week for five weeks which equaled fifteen sessions. The laser treatment was applied after each exercise session. The exercising consisted of climbing and weights attached to the tail of the rats. The result analysis showed that TLG had a reduced amount of lactate level and a decreased muscle glycogen depletion than the TG. There was an increase in the muscle fibers in the leg muscles. These results could have played a part in the improvement of muscle performance. This is important to the discourse community because it is positive results. These results could lead to many more studies and there could become a better understanding of the effects of low-level laser therapy. Pertille A, Macedo A, Oliveira C. Evaluation of muscle regeneration in aged animals after treatment with low-level laser therapy. / Avaliao da regenerao muscular em animais idosos aps tratamento com laser de baixa intensidade. Brazilian Journal Of Physical

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Therapy / Revista Brasileira De Fisioterapia [serial online]. November 2012;16(6):495501. Available from: SPORTDiscus, Ipswich, MA. Accessed March 13, 2014. Adriana Pertille, Aline B. Macedo, and Cssio P.V. Oliveira are the authors and researchers of this study. They are in the Graduate program in Physical Therapy at the Methodist University of Piracicaba in Brazil. The objective of this study was to see if low level laser therapy would be effective on old rats after contusion, which is a region of injured tissue. They used a total of twenty-five rats with an age of eighteen months old. They were randomly placed into three groups: control group (CT), injured group without treatment (IN), and treated with laser group (LA). The LA and IN groups were then split in half to test for seven and twenty-one sessions. The laser was applied at two points for sixteen seconds each. After twenty-one days the researchers found that there was a decrease in inflammation in the LA group compared to the IN group. They found in group IN twenty-one group had a reduction in MyoD, which is a protein that regulates muscle differentiation (separation), compared to the CT group. These results show that low level laser therapy can be effective but only in the case of reducing inflammation. This is important to the discourse community because this study could be taken further to be studied on humans and help with inflammation. Sharma R, Thukral A, Kumar S, Bhargava S. Effect of Low Level Lasers in de Quervains Tenosynovitis. Physiotherapy [serial online]. 2002 ;( 12):730. Available from: Academic OneFile, Ipswich, MA. Accessed February 27, 2014. The four writers and researchers of this academic journal all have different jobs at the Guru Teg Bahadur Hospital and University College of Medical Sciences in Delhi, India. The study they operated was about Quervains Tenosynovitis. Quervains Tenosynovitis is

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inflammation of the sheath that borders the two tendons that control the movement of the thumb. The researchers were looking to increase the patients ability to pinch and grip objects. They also wanted to see if the lasers effected the sheaths (two different forearm muscles), antero-postereior and medio-lateral, diameters. The study was a double-blind test, consisting of twenty-eight female patients using thirty limbs. All the patients were dominantly right handed. Half were placed in the placebo group while the others were placed in the tested group. There was a maximum of ten treatments that were given to the test group. The study found an increase in peoples grips and the punch strength and also found a decrease in the diameters of the tendon sheaths to a normal size. The study was very small but showed that laser therapy could be beneficial to people with Quervains tenosynovitis. This academic journal is suited for the conversation because it shows a positive development in the use of laser surgery for inflammation in tendons around the hand. Silva-Couto M, Gigo-Benato D, Tim C, Parizotto N, Salvini T, Russo T. Effects of low-level laser therapy after nerve reconstruction in rat denervated soleus muscle adaptation. / Efeitos do laser de baixa potncia aps reconstruo nervosa na adaptao do msculo sleo de rato. Brazilian Journal of Physical Therapy / Revista Brasileira De Fisioterapia [serial online]. July 2012; 16(4):320-327. Available from: SPORTDiscus, Ipswich, MA. Accessed March 5, 2014. The entire group of author are part of the Physical Therapy Department at the Federal University of So Carlos, in Brazil. The study they tested was to find the effects of different wavelengths after neurotmesis, severe nerve injury where they cut the nerve and the nerve sheath. They did this to the soleus muscle (part of the calf). Sixty-four male rats

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were the test subjects. They were split into eight groups (1) the control group (2) the group that got the placebo and (3-8) were tested with different wavelengths and energy. Radiation was tested on two test points, above and below the scar from the neurotmesis. The applications were done daily for ten days consecutively. The lasers cause no pain and the animals were handled with care. In their research they found that an enzyme called metallopeptidases (MMPs), which helps recovery after nerve injuries, had reached normal levels. They found no difference among the peripheral never injury groups submitted or not submitted to the low-level laser in any variable. They concluded that more studies are necessary. This is important to the discourse community because even though the research findings were not what they were looking for, there could be further research with low level laser without any distress. Toma R, Tucci H, Muniz Renno A, et al. Effect of 808 nm low-level laser therapy in exerciseinduced skeletal muscle fatigue in elderly women. Lasers in Medical Science [serial online]. n.d.; 28(5):1375-1382. Available from: Biological Abstracts 1969 - Present, Ipswich, MA. Accessed March 1, 2014. Out of the nine authors of this academic journal, eight work in the medical division at Federal University of So Paulo, while the last writer/researcher works at the University of Estadual Paulista. The experiment was to try and decrease fatigability in elderly people. The study was done on twenty-four elderly women from the ages sixty to seventy. The subjects were split into two groups in a randomized triple-blinded controlled test. The volunteers, the researchers that were in charge of the laser treatment, and the researchers collected the data were blind about the treatments. The study consisted of two stages. The first stage was when the base line data was collected doing exercises before

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the laser therapy. The second stage was after the laser therapy when they did the same exercises that they did before the therapy. For this they used the dominant lower limb like hip, knee, and ankle flexion. There are eight laser treatment points. The results from this study found an increase in muscle performance in the group that received the laser therapy. They did find that there was no significant difference in fatigability. This is important to the discourse community because it shows a positive improvement in laser therapy that is tested on humans. Vieira W, Ferraresi C, Perez S, Baldissera V, Parizotto N. Effects of low-level laser therapy (808 nm) on isokinetic muscle performance of young women submitted to endurance training: a randomized controlled clinical trial. Lasers In Medical Science [serial online]. March 2012; 27(2):497-504. Available from: MEDLINE, Ipswich, MA. Accessed March 6, 2014. The five authors of this academic journal, Wouber Herickson de Brito Viera, Cleber Ferraresi, Sergio Eduardo de Andrade Perez, Vilmar Baldissera, Nivaldo Antonio Parizotto, work at the Federal University of So Carlos in the physical therapy department. This study is similar to another study done by some of the same researcher. This study set out to test if endurance training and low level laser therapy can increase a humans performance when compared to just training alone. What is different about this study is that the two main objectives were to find the fatigue index of the knee extensor muscle (FIext) and to find the total work of the knee extensor muscles (TWext). The study included forty-five women with the mean age of twenty-one. They were split into three groups, the control group, the training group, and lastly the training group with low level laser therapy. The training lasted nine weeks. After each training session the laser

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was applied to the quadriceps. Only the training group with laser therapy showed a decrease in FIext. The training group with laser and the training group alone both had an increase in TWext. This is important to the discourse community because it is a new way that can help with rehabilitation and people involved in endurance training with injuries.